Diversification of response to hsp65 during the course of autoimmune arthritis is regulatory rather than pathogenic

Summary: Determinant spreading has been implicated in the pathogenesis of certain autoimmune diseases in animal models. We have observed that during the course of adjuvant arthritis (AA) in the Lewis rat, there is 'diversification' of response to the bacterial 65-kDa heat shock protein (Bhsp65) towards its carboxy-terminal determinants (BCTD). Strikingly, pretreatment of naive Lewis rats with BCTD affords significant protection from AA. Our preliminary studies indicate that the diversification of response to BCTD in the Lewis rat is probably triggered in vivo by the induction and enhanced processing of self(rat) hsp65. Thus, the self hsp65-directed T-cell responses appear to be involved in mediating natural remission from acute inflammatory arthritis induced by a foreign antigen, Myco-bacterium tuberculosis. This the first report describing that the new T-cell specificities arising during the course of an autoimmune disease are regulatory/protective rather than pathogenic. Moreover, our results suggest that a final common mechanism involving BCTD might be recruited by other rac strains which either are resistant to AA (WKY rats) or whose susceptibility to AA is modulated significantly by microbial flora (Fisher rats). The results of this study would contribute significantly to understanding of the pathogenesis of human rheumatoid arthritis, and in devising new therapeutic strategies for this disease.     

Associations of place of birth with asthma and wheezing in Mexican American children

BACKGROUND: There are wide global variations in the prevalence of asthma and wheezing. OBJECTIVES: We examined the associations of place of birth with doctor-diagnosed asthma, wheezing in the past 12 months, and other allergic conditions in Mexican American children. METHODS: The study used data on 4121 Mexican American children age 2 months to 16 years who participated in the Third National Health and Nutrition Examination Survey. RESULTS: The risk of asthma was associated with being born in the United States after adjusting for sex, age, history of ear infection, and having a regular place for health care (odds ratio, 2.19; 95% CI, 1.09-4.40). Among children with no previous history of ear infection, US-born children were more likely to report wheezing in the past 12 months than their peers born in Mexico after controlling for confounding variables (odds ratio, 2.05; 95% CI, 1.09-3.87). Mexican American children born in the United States were more likely to have positive skin reaction to cat, house mite, Alternaria alternata , peanut, Bermuda grass, and short ragweed but were less likely to have a positive skin test to German cockroaches after adjusting for sex, age, ear infection, having a regular place for health care, and area of residence. CONCLUSION: Our study indicated significant associations of place of birth with respiratory symptoms and allergic conditions in Mexican American children. These findings highlight the need for further studies to examine environmental factors that change by migration and explain the observed differential in the risk of asthma or wheezing.     

HCV-specific CD27- CD28- memory T cells are depleted in hepatitis C virus and Schistosoma mansoni co-infection

Factors that influence the generation and maintenance of memory CD8+ T cells are not fully understood. The homeostasis of memory T cells is highly dynamic and tightly regulated by various stimuli, including cytokines and antigen-major histocompatibility complex ligands. We characterized the hepatitis C virus (HCV)-specific CD8+ T-cell responses in a cohort of HCV-infected individuals with or without Schistosoma mansoni co-infection from Egypt. We observed a significantly decreased CD27- CD28- (late differentiated) memory T-cell population in the HCV co-infected individuals compared to those with HCV infection alone. In contrast, there was no significant difference in the CD27+ CD28+ (early differentiated) memory T cells between the two groups. Analysis of human cytomegalovirus-specific CD8+ T-cell responses in the same individuals failed to reveal a similar pattern of altered memory T-cell differentiation. Thus, S. mansoni co-infection targets a specific subset of memory CD8+ T cells in HCV infection.     

Efficacy of allogeneic cord blood platelet gel on wounds of dystrophic epidermolysis bullosa patients after pseudosyndactyly surgery

Epidermolysis bullosa (EB) is a rare genetic disorder characterized by the formation of blisters and wounds in skin and mucous membranes; it is classified into four types and has various methods of treatment. Management of previous wounds and prevention of formation of new lesions are the most important strategies in the course of therapy to improve patient's quality of life; lack of wound management can lead to further complications such as infection. The current study investigated the therapeutic effects of allogeneic platelet gel (prepared from umbilical cord blood) in a group of children diagnosed with dystrophic epidermolysis bullosa (DEB) eligible for surgical correction of pseudosyndactyly in the hand. The post‐surgical clinical outcome in this group was compared with the clinical outcomes of DEB patients receiving the standard treatment (paraffin gauze wound dressing and topical antibiotics) after corrective surgery. The current study results showed an increase in the rate of recovery and promotion of tissue granulation, complete wound healing, and a decrease in pain level and treatment period. The application of cord blood platelet gel topical dressing was not a conventional method of treatment in patients with DEB wounds and blisters. However, the current study results demonstrated that this gel dressing could effectively accelerate epithelialization and healing of the wounds and decrease patients' pain and post‐surgical recovery period, which altogether leads to improvements in patients' overall quality of life.     

Efficacy and tolerability of anti-asthma herbal medicine intervention in adult patients with moderate-severe allergic asthma

BACKGROUND: Chinese herbal medicine has a long history of human use. A novel herbal formula, anti-asthma herbal medicine intervention (ASHMI), has been shown to be an effective therapy in a murine model of allergic asthma. OBJECTIVE: This study was undertaken to compare the efficacy, safety, and immunomodulatory effects of ASHMI treatment in patients with moderate-severe, persistent asthma with prednisone therapy. METHODS: In a double-blind trial, 91 subjects underwent randomization. Forty-five subjects received oral ASHMI capsules and prednisone placebo tablets (ASHMI group) and 46 subjects received oral prednisone tablets and ASHMI placebo capsules (prednisone group) for 4 weeks. Spirometry measurements; symptom scores; side effects; and serum cortisol, cytokine, and IgE levels were evaluated before and after treatment. RESULTS: Posttreatment lung function was significantly improved in both groups as shown by increased FEV(1) and peak expiratory flow findings (P<.001). The improvement was slightly but significantly greater in the prednisone group (P<.05). Clinical symptom scores, use of beta(2)-bronchodilators, and serum IgE levels were reduced significantly, and to a similar degree in both groups (P<.001). T(H)2 cytokine levels were significantly reduced in both treated groups (P<.001) and were lower in the prednisone-treated group (P<.05). Serum IFN-gamma and cortisol levels were significantly decreased in the prednisone group (P<.001) but significantly increased in the ASHMI group (P<.001). No severe side effects were observed in either group. CONCLUSION: Anti-asthma herbal medicine intervention appears to be a safe and effective alternative medicine for treating asthma. In contrast with prednisone, ASHMI had no adverse effect on adrenal function and had a beneficial effect on T(H)1 and T(H)2 balance.     

Tuberculous otitis media-are we missing it ?

Tuberculosis of the middle ear it a rare disease. Due to change in the typical clinical pattern and decrease in incidence, there is a delayed or missed diagnosis and can lead to increased morbidity. We pretent 5 cases of Tuberculous Otitis Media treated over a period of 2 years, highlighting the fact that it must be considered as a differential diagnosis of persistent suppurative otitis media.     

Respiratory syncytial virus infection: Clinical presentation and management

Summary RSV infection continues to be a major cause of morbidity and mortality throughout the world. Despite advances in the understanding of its pathogenesis, limited progress has been made in prevention and treatment of RSV infection. Based on the experiences thus far it seems that control of RSV infection will be a difficult and complex task.     

Developing and testing of an Egyptian version of Children's Health Locus of Control scale

The purpose of this study is to develop and test the reliability and validity of an Egyptian version of the Children's Health Locus of Control scale. A cross sectional study design was applied using a stratified random sample of 930 students from the final two grades of primary and all grades of the preparatory schools. A further convenience sample of 120 students was selected to examine test-retest reliability of the scale. A preliminary instrument was developed and consisted of 40 statements having one of two response forms; a Yes/No format and a 4-point Likert scale format From data analysis the later format showed higher validity and reliability than the former one. Construct validity of the scale is evidenced by the factor analysis which revealed five factors (Internal, Chance, Powerful Others, Fate and Self blame) consistent with the previous theoretical model of HLC. As indicated by eta coefficient the scale and the subscales showed strong discriminating power between subjects. The known group comparison indicated a good criterion validity of the scale and the subscales. The scale showed a considerable reliability as alpha coefficient was 0.73 with test-retest reliability of 0.65. Comparison of different groups of students indicated that the scale could be used with confidence for all age groups, though it was more reliable for the preparatory phase, for private and governmental schools for males and females and for different social strata. Further testing of the developed scale is indicated among Egyptian children in different cultures.     

Calcified catheter “cast”: a rare complication of indwelling central venous catheters in infants

Peri-catheter calcification is an unusual and previously unreported complication of central venous (CV) catheterization in infants. A 1.9 Fr Silastic CV catheter was placed in a term infant for administration of total parenteral nutrition and antibiotics following intra-abdominal sepsis. The catheter was removed, without complication, at a later date after another septic episode. Imaging studies performed in the investigation of a possible intra-abdominal abscess revealed a cylindrical density within a clot in the inferior vena cava (IVC). The density was presumed to be a retained catheter fragment. Further investigation indicated total occlusion of the IVC. Surgical exploration of the IVC revealed only a calcified thrombus. This case represents a rare and previously unreported complication of CV catheterization in infants. Diagnosing this condition on radiographic evidence alone can be difficult. It is hoped that awareness of the potential for this complication will avoid unnecessary invasive procedures in the future. We also suggest a high level of clinical suspicion and routine Doppler ultrasound investigations to detect IVC thrombosis when indwelling CV catheters are used in infants. Accepted: 15 July 1997